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A condition with a high risk of malignant transformation
Insidious chronic precancerous condition affecting any part of oral cavity & sometimes the pharynx.

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It is preceded by and/or associated with vesicle
formation and is always associated with juxta
epithelial inflammatory reaction followed by
progressive hyalinization of lamina propria

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Later → Subepithelial and submucosal myofibrosis leads to stiffness of oral mucosa and deeper C/T with progressive limitation in opening of the mouth and protrusion of tongue leading to difficult in eating, swallowing and phonation

(5) Immunological Factors :

(5) Immunological Factors Prolong immunosuppression can cause likelihood of malignant transformation because Helper T-cell play a vital role in functional differentiation of B-cells and production of interleukin-2
Decreased interleukin 2 production →↓ cellular & humoral immune response → prone to OSMF
High levels of circulating immune complex (CIC)
seen in OSMF

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(6) Nutritional Factors
Iron metabolism is important in maintaining the health of the oral mucosa and upper GI tract
Precondition of oral mucosa, chronic deficiency of iron & vitamin B complex acts as important role

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CLINICAL FEATURES :

CLINICAL FEATURES The onset is insidious over 2-5 years period
Prodromal symptoms include;
burning sensation in the mouth when consuming spicy food
appearance of blister especially in the palate; ulceration or generalized inflammation of the oral mucosa
excessive salivation; defective gustatory sensation & dryness of the mouth

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Early stage → Focal vascular dilatations clinically manifests as petechiae (may be vascular response due to hypersensitivity of oral mucosa to some irritants like chilli)
Petechiae were observed mostly in the tongue followed by labial and buccal mucosa with no sign of blood dyscrasia or systemic disorders
As the disease progresses, oral mucosa become blanched and slightly opaque and white thick fibrous band appear

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Oral mucosa is symmetrically involved & fibrous band in the oral mucosa run in vertical direction
Severe cases →Deviation of uvula (+)
Inability to whistle or blow out
a candle
Difficulty in swallowing

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Pterygomandibular raphe involvement (+)→ Limitation of mouth opening (+)
Most of the patient experience a protracted period of stomatitis and/or glossitis with remission and exacerbation
If fibrosis involves pharynx→ patient experience referred pain in ear
Nasal voice as one of the later signs in some patients (MILLARD)

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By means of gauge 27 dental needle not more than 0.2ml solution for period of 20 weeks
* (Massaging the cheeks with mouth closed. Asking the patient to perform mouth opening exercises for 30min after the submucosa injection)